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. 2012 May;132(5):617-25.
doi: 10.1007/s00402-011-1456-5. Epub 2012 Jan 10.

Systematic review of the complications of plate fixation of clavicle fractures

Frans-Jasper G Wijdicks  1 , Olivier A J Van der Meijden, Peter J Millett, Egbert J M M Verleisdonk, R Marijn Houwert
Affiliations

Systematic review of the complications of plate fixation of clavicle fractures

Frans-Jasper G Wijdicks et al. Arch Orthop Trauma Surg. 2012 May.

Abstract

Background: The number of displaced midshaft clavicle fractures treated surgically is increasing and plate fixation is often the treatment modality of choice. The study quality and scientific levels of evidence at which possible complications of this treatment are presented vary greatly in literature.

Purposes: The purpose of this systematic review is to assess the prevalence of complications concerning plate fixation of dislocated midshaft clavicle fractures.

Methods: A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Studies included for review reported complications after plate fixation alone or in comparison to either treatment with intramedullary pin fixation and/or nonoperative treatment. Two quality assessment tools were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence.

Results: After study selection and reading of the full texts, 11 studies were eligible for final quality assessment. Nonunion and malunion rates were less than 10% in all analysed studies but one. The vast majority of complications seem to be implant related, with irritation or failure of the plate being consistently reported on in almost every study, on average ranging from 9 to 64%.

Conclusion: The quantity of relevant high evidence studies is low. With low nonunion and malunion rates, plate fixation can be a safe treatment option for acute dislocated midshaft clavicle fractures, but complications related to the implant material requiring a second operation are frequent. Future prospective trials are needed to analyse the influence of various plate types and plate position on implant-related complications.

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Figures

Fig. 1
Fig. 1
Flowchart demonstrating the article search and appraisal process. Search was conducted on April 6th 2011. Asterisk excluded were one case report [29] and two studies in which there was no clear distinction made between postoperative complications after acute fractures and nonunions [9, 14]. Seven studies included complicated fractures and made no distinction with uncomplicated fractures when describing complications [, , , –20, 32]. One study was a surgical technique paper [2], one study only reported outcomes and no complications [28], two studies had no clear definition of indication for surgery [1, 38] and, finally, two studies included different kinds of clavicle fractures (pathological, distal and nonunions) [11, 26]
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